Can Administrative Claim File Review Be Used to Gather Physical Therapy, Occupational Therapy, and Psychology Payment Data and Functional Independence Measure Scores? Implications for Rehabilitation Providers in the Private Health Sector

This study explored whether existing electronic claim files could be used to easily gather information about rehabilitation costs and functional status for people with spinal cord injuries (SCI). The research focused on individuals with work-related SCI to see if their claim files contained useful data on payments for physical therapy, occupational therapy, and psychology services, along with a measure of functional independence. The researchers looked at 28 electronic claim files from the Workplace Safety and Insurance Board (WSIB) of Ontario, focusing on individuals who had sustained a work-related SCI. They tried to extract data on payments for the aforementioned therapies and Functional Independence Measure (FIM) scores, which indicate a person's ability to perform daily tasks independently. The study concluded that using administrative claim files in their current format is not practical for gathering the desired data. The information was not consistently organized or complete, making it difficult to use for research purposes. The authors suggest that a more standardized approach to collecting, recording, and sharing data within the rehabilitation industry is needed to improve research and best practices.

• 1
  The process of administrative e-claim file review was not practical for extraction of the targeted data, which included payment data for PT, OT, and psychology services, as well as FIM scores.
• 2
  The data extracted were considered incomplete, as they did not match the assumptions developed for payment data. For example, it was expected that all e-claim files for persons with complete tetraplegia would yield payment data for OT and PT services, but this was not the case.
• 3
  There was no FIM score data extracted from any of the e-claim files.